1. What combination of assessment findings determines nutritional status in these two patients?
Nutritional status is the balance between a patient’s current nutritional supply and demand (Sole, Klein, Moseley, 2013, p. 81). In a critical care area, patients have special nutritional needs because the stress of their complex illness increases their metabolic rate and nutritional needs, In addition, they are assumed to be at nutritional risk due to lack of mobilization which can result to muscle atrophy. Nutritional support is an integral part of the patient’s care (Moore, 2016). Mr. H’s nutritional status can be determined by assessing the following: he is at postoperative day 4 after coronary artery bypass graft surgery, has not eaten significant …show more content…
Nasoduodenal route or naso jejunal for short-term feeding is preferred route. . However, for long-term, gastrostomy tube inserted endoscopically or jejuostomy tube surgically inserted are also preferred .Nasogastric route is not preferred for short-term due to risk of aspiration. Mr. J was admitted due to pneumonia, he requires intubation and says that when he tries to swallow, food gets caught in his throat. This means he is at risk of aspiration. In addition, enteral feeding is preferred to parenteral feeding due to less infection and preserves gut integrity by preventing bacterial overgrowth and migration of bacteria to the blood stream. Since Mr. J is receiving 5% D5W with 0.45% saline, the nurse should monitor hyperglycemia, fluid imbalances and electrolyte imbalances. However, if the patient is not tolerating enteral nutrition, parenteral nutrition may be tried. In addition, parenteral nutrition is recommended for patients with GI obstruction, NPO for greater than I week, such as bowel resection and patients who are admitted very malnourished & unable to tolerate enteral feeding (Moore, 2016). Mr. J needs high protein enteral feeding since he is in intensive care unit, an elderly patient, and has critical …show more content…
H‘s short and long term goals are the following:
Patient will consume adequate nourishment
Patient will have stable lab values (prealbumin & albumin).
Patient will gain weight (Ackley & Ladwig, 2013, p. 559).
Mr. J’s patient short and long term goals are the following:
Patient will demonstrate improved ventilation and adequate oxygenation as evidenced by blood gas levels within normal parameters.
Patient will maintain clear lung fields and remain free of signs of respiratory distress
Patient will verbalize understanding of oxygen supplementation and other therapeutic intervention (Ackley & Ladwig, 2013, p. 375)
References
Ackley, J. B., Ladwig, B. G. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.). Maryland Heights, MO: Mosby Elsevier
Moore, H. (2016). Power point on Nutritional Support. Retrieved from https://cluster1-files.instructure.com/courses/1861272/files/89113000/course%20files/Captivate/Module%206/Nutritional%20Support/multiscreen.html?download=1&inline=1&sf_verifier=d3503c9d89c22a111d5af7813af470b4&ts=1476363201&user_id=5990799
Sole, M.L., Klein, D.G., & Moseley, M.J. (2013). Introduction to Critical Care Nursing.( 6th edition.) St. Louis, MO:
Nutritional status is the balance between a patient’s current nutritional supply and demand (Sole, Klein, Moseley, 2013, p. 81). In a critical care area, patients have special nutritional needs because the stress of their complex illness increases their metabolic rate and nutritional needs, In addition, they are assumed to be at nutritional risk due to lack of mobilization which can result to muscle atrophy. Nutritional support is an integral part of the patient’s care (Moore, 2016). Mr. H’s nutritional status can be determined by assessing the following: he is at postoperative day 4 after coronary artery bypass graft surgery, has not eaten significant …show more content…
Nasoduodenal route or naso jejunal for short-term feeding is preferred route. . However, for long-term, gastrostomy tube inserted endoscopically or jejuostomy tube surgically inserted are also preferred .Nasogastric route is not preferred for short-term due to risk of aspiration. Mr. J was admitted due to pneumonia, he requires intubation and says that when he tries to swallow, food gets caught in his throat. This means he is at risk of aspiration. In addition, enteral feeding is preferred to parenteral feeding due to less infection and preserves gut integrity by preventing bacterial overgrowth and migration of bacteria to the blood stream. Since Mr. J is receiving 5% D5W with 0.45% saline, the nurse should monitor hyperglycemia, fluid imbalances and electrolyte imbalances. However, if the patient is not tolerating enteral nutrition, parenteral nutrition may be tried. In addition, parenteral nutrition is recommended for patients with GI obstruction, NPO for greater than I week, such as bowel resection and patients who are admitted very malnourished & unable to tolerate enteral feeding (Moore, 2016). Mr. J needs high protein enteral feeding since he is in intensive care unit, an elderly patient, and has critical …show more content…
H‘s short and long term goals are the following:
Patient will consume adequate nourishment
Patient will have stable lab values (prealbumin & albumin).
Patient will gain weight (Ackley & Ladwig, 2013, p. 559).
Mr. J’s patient short and long term goals are the following:
Patient will demonstrate improved ventilation and adequate oxygenation as evidenced by blood gas levels within normal parameters.
Patient will maintain clear lung fields and remain free of signs of respiratory distress
Patient will verbalize understanding of oxygen supplementation and other therapeutic intervention (Ackley & Ladwig, 2013, p. 375)
References
Ackley, J. B., Ladwig, B. G. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.). Maryland Heights, MO: Mosby Elsevier
Moore, H. (2016). Power point on Nutritional Support. Retrieved from https://cluster1-files.instructure.com/courses/1861272/files/89113000/course%20files/Captivate/Module%206/Nutritional%20Support/multiscreen.html?download=1&inline=1&sf_verifier=d3503c9d89c22a111d5af7813af470b4&ts=1476363201&user_id=5990799
Sole, M.L., Klein, D.G., & Moseley, M.J. (2013). Introduction to Critical Care Nursing.( 6th edition.) St. Louis, MO: